Execution
- 1Screen the history for cervical arterial dysfunction red flags before any positional testing.
- 2Position the patient supine and passively moves the head and neck into extension and side flexion.
- 3Add rotation to the same side or uses the planned sustained rotation-extension position.
- 4Hold the position for about 10 to 30 seconds while observing speech, eye movement, facial signs, nausea, dizziness, and neurological status.
- 5Return the head to neutral and repeat only if clinically justified and safe.
Positive outcome
Dizziness, nystagmus, diplopia, dysarthria, dysphagia, nausea, numbness, drop attack, pallor, sweating, or other neurological symptoms are positive and require stopping. A negative test does not rule out cervical arterial dysfunction or guarantee safety for manipulation. Symptoms during testing may also reflect vestibular or cervical causes rather than vascular compromise.
Studies
| Study | Reliability | Sn | Sp | LR+ | LR− |
|---|---|---|---|---|---|
| Hutting et al. (2013) | systematic review of VBI tests | 0-57 | 67-100 | NA | NA |
| Rushton et al. (2014) | IFOMPT clinical reasoning framework | NA | NA | NA | NA |
| Hutting et al. (2020) | position statement | NA | NA | NA | NA |
CommentMagee describes sustained cervical rotation/extension vascular positions and warns that dizziness or nystagmus suggests vertebral artery compression. Modern cervical arterial dysfunction frameworks question the diagnostic accuracy of positional VBI tests, with sensitivity sometimes near zero. This test should be considered a precautionary symptom provocation screen, not a rule-out test.
Low Clinical Value